Notes from the Golden Orange

EppsNet Archive: Healthcare Reform

In Britain, even though they’re already paying for the National Health Service, six million Brits — two-thirds of citizens earning more than $78,700 — now buy private health insurance. Meanwhile, more than 50,000 travel out of the U.K. annually, spending more than $250 million, to receive treatment more readily than they can at home.

The conversation below took place more than four years ago — June 23, 2009 — at a congressional hearing on Obamacare. The topic was the keep-your-coverage promise, and the participants were Christina Romer, then chair of the Council of Economic Advisers, and Rep. Tom Price, who is also a doctor.

The conversation plays out like one of those word puzzles where you start out with one word and change one letter at a time to get a completely different word. Watch Romer’s responses on keeping your coverage go from “Absolutely” to a stammering “I’d have to look at the specifics.”

REP. PRICE: You also mentioned, as other folks have, that the president’s goal — and it’s reiterated over and over and over — that if you like your current plan or if you like your current doctor, you can keep them. Do you know where that is in the bill?

MS. ROMER: Absolutely. And things like the employer mandate is part of making sure that large employers that today — the vast majority of them do provide health insurance. One of the things that’s —

REP. PRICE: I’m asking about if an individual likes their current plan and maybe they don’t get it through their employer and maybe in fact their plan doesn’t comply with every parameter of the current draft bill, how are they going to be able to keep that?

MS. ROMER: So the president is fundamentally talking about maintaining what’s good about the system that we have. And —

REP. PRICE: That’s not my question.

MS. ROMER: One of the things that he has been saying is, for example, you may like your plan and one of the things we may do is slow the growth rate of the cost of your plan, right? So that’s something that is not only —

REP. PRICE: The question is whether or not patients are going to be able to keep their plan if they like it. What if, for example, there’s an employer out there — and you’ve said that if the employers that already provide health insurance, health coverage for their employees, that they’ll be just fine, right? What if the policy that those employees and that employer like and provide for their employees doesn’t comply with the specifics of the bill? Will they be able to keep that one?

MS. ROMER: So certainly my understanding — and I won’t pretend to be an expert in the bill — but certainly I think what’s being planned is, for example, for plans in the exchange to have a minimum level of benefits.

REP. PRICE: So if I were to tell you that in the bill it says that if a plan doesn’t comply with the specifics that are outlined in the bill that that employer’s going to have to move to the — to a different plan within five years — would you — would that be unusual, or would that seem outrageous to you?

MS. ROMER: I think the crucial thing is, what kind of changes are we talking about? The president was saying he wanted the American people to know that fundamentally if you like what you have it will still be there.

REP. PRICE: What if you like what you have, Dr. Romer, though, and it doesn’t fit with the definition in the bill? My reading of the bill is that you can’t keep that.

MS. ROMER: I think the crucial thing — the bill is talking about setting a minimum standard of what can count —

REP. PRICE: So it’s possible that you may like what you have, but you may not be able to keep it? Right?

When President Obama said that he could provide health care to millions without taking any health care away from people who have already got it, he had no chance of being believed. The statement was absurd on its face. This is a law of arithmetic: If you invite a bunch of friends to share your lunch, there’s going to be less lunch for you. Everybody understands that. . . .

So when the President said he could expand the availability of medical care while allowing everyone else to keep the care they’ve got, it was like saying he’d take us for a tour of England in his rocket ship. It had absolutely no chance of being believed, and therefore, it seems to me, does not count as a lie.

It counts instead as an expression of contempt for the many entirely reasonable people who tried to point out that it is not within a President’s power to suspend the laws of arithmetic.

That expression of contempt was arguably pretty contemptible, and arguably as contemptible as a lie. And of course he’s compounding it by trying to tell you with a straight face that everyone who has to switch health plans will end up with “better” plans that allow them to consume even more medical care. I could give you some pretty striking counterexamples among people I’m personally close to, but there’s no need for that, since anyone who grasps basic arithmetic can see that the president’s words cannot be true. But speaking untruths is not enough to make him a liar. For that, he’d have to speak plausible untruths, and he has too little respect for the American people to bother coming up with any.

Cindy Vinson and Tom Waschura are big believers in the Affordable Care Act. They vote independent and are proud to say they helped elect and re-elect President Barack Obama.

Yet, like many other Bay Area residents who pay for their own medical insurance, they were floored last week when they opened their bills: Their policies were being replaced with pricier plans that conform to all the requirements of the new health care law.

Vinson, of San Jose, will pay $1,800 more a year for an individual policy, while Waschura, of Portola Valley, will cough up almost $10,000 more for insurance for his family of four. . . .

Covered California spokesman Dana Howard maintained that in public presentations the exchange has always made clear that there will be winners and losers under Obamacare. . . .

“Of course, I want people to have health care,” Vinson said. “I just didn’t realize I would be the one who was going to pay for it personally.”

Actually, because the plan cost that triggers the Cadillac tax is not indexed for inflation, Bradley Herring, a health economist at Johns Hopkins Bloomberg School of Public Health, estimates that as many as 75 percent of plans could be affected by the tax over the next decade.

The hospital where Abbey Bruce, a nursing assistant in Olympia, Wash., worked, for example, stopped offering the traditional plan that she and her husband, Casey, who has cystic fibrosis, had chosen. . . .

She has had to drop out of school and take on additional jobs to pay for her husband’s medicine.

“My husband didn’t choose to be born this way,” Ms. Bruce said. The union representing her, a chapter of the Service Employees International Union, has objected to the changes. Her employer, Providence Health & Services, says it designed the plans to avoid having employees shoulder too much in medical bills and has reduced how much workers pay in premiums.

Abbey Bruce, a nursing assistant who works a second job cleaning, will pay a sharply higher deductible.

Cynthia Weidner, an executive at the benefits consultant HighRoads, [said] that the tax appeared to be having the intended effect. “The premise it’s built upon is happening,” she said, adding, “the consumer should continue to expect that their plan is going to be more expensive, and they will have less benefits.”

Key takeaway: Pay more. Get less.

I hate to say I told you so, so instead I’ll say say an insincere thank you to Obama and all the delusional fuckers who voted for this goddamn law.

Health insurance companies across the country are seeking and winning double-digit increases in premiums for some customers, even though one of the biggest objectives of the Obama administration’s health care law was to stem the rapid rise in insurance costs for consumers.

That headline should not read “DESPITE new health law,” it should read “BECAUSE OF new health law.”

But we were going to get things for free! We were promised better things at a lower cost!

In my day, most of the citizens were farmers or merchants or tradesmen. They lived by their hands and their wits. They had horse sense and they knew when they were being sold a bill of goods.

Of course, that was before television.

Americans today are unfortunately rather stupid. Most of them don’t know anything about economics, science, history, government . . . as George Carlin says, “Think of how stupid the average person is, and realize half of them are stupider than that.” George is here in heaven now. He breaks me up, he really does.

Your president and Congress have decreed that every American will have health insurance whether they want it or not. They have further decreed that a lot of Americans will not have to pay for their own health insurance, which means that the cost of their health insurance has to be paid by the rest of you. That’s one reason why your health insurance premium is going up.

Another reason your premium is going up is the “guaranteed issue” provision. “Guaranteed issue” means that no one can be denied health insurance because of pre-existing conditions.

Funny story: My friend Paul Epps, his wife has an insurance agency in Southern California. It’s an area that’s susceptible to wildfires in the summer months. When a fire breaks out, people who live near the fire actually call this woman wanting to buy a homeowners policy.

Of course, she doesn’t sell it to them. Insurance companies are a little bit smarter than that.

Buying a homeowners policy when your house is already on fire is analogous to “guaranteed issue” health insurance: Hello, I’d like to buy some health insurance. Oh by the way, I have cancer, but the doctors think that with lengthy and expensive treatment, I have a chance to pull through.

This is not even insurance anymore. Insurance is something you pay for now to protect against the risk of having to pay a lot more later. In these cases, there IS no risk. The bad news has already happened. It’s a dead loss for the insurance company and they have to spread the cost of that loss to other policyholders. That’s another reason your premium is going up.

You really can’t dispute something as vague as that but it does raise a number of questions:

What does it mean for thousands of pages of legislation affecting the entire healthcare industry as well as every man, woman and child in America to go “as intended”? It’s a circular argument. If it goes as intended, we save $11 billion. If we don’t save $11 billion, it didn’t go as intended.

Is “widespread utilization and automation” part of going “as intended” or is that a separate thing?

Assuming that implementation does go as intended and widespread utilization and automation are achieved, the best we can say is that providers “could” save “about” $11 billion per year? Could they save more? Less? Break even? Could they lose $11 billion? It’s meaningless speculation.

Can anyone remind me of a large-scale government program that went “as intended” and saved everyone a lot of money?

Why, despite all evidence to the contrary, do people continue to believe that government can successfully engineer social aspirations?

In other news, if my plan to grow wings on pigs goes as intended, it could revolutionize the way we export bacon.

These things never go as intended. They can’t possibly go as intended. There are alwaysunintended consequences. I can’t implement a policy in my own house and have it go as intended and there’s just two people and a dog.

I asked the friend who called the NEJM article to my attention what going “as intended” means in the context of the ACA and he said, “I think it means legislators don’t muck with it too much.” What does “muck” mean? What does “too much” mean? We could go on and on . . .

David Henderson says — accurately, I think — that Mitt Romney’s “47 percent” remarks can be paraphrased as “People who are dependent on government will vote for the candidate who credibly (to them, at least) promises to keep the programs that have created that dependence.”

Do you think President Obama disagrees with that? He doesn’t.

If you think he does, please see The Life of Julia on the president’s web site. It lays out a “typical” woman’s cradle-to-grave dependence on government assistance and describes how Obama will keep those programs going while Mitt Romney won’t.

The most insulting thing about it is that as you read about Obama funding this and Obama funding that, it sounds like he’s doing it all out of his own goddamn pocket. What a prince!

There’s no acknowledgement that Obama is taking from some and giving to others, and that all of Julia’s “free” stuff is paid for by me and people like me out of money earned by our own labor.

And we are struggling. We’re putting a kid through college, my wife has had an expensive medical condition, our home equity has plummeted, the roof leaks, my car is long overdue for new tires . . . there are unplanned expenses . . . next month, something else will break. That’s life.

As part of our middle-class existence, we pay a five-figure annual federal income tax bill. We pay for Julia’s babysitters, education, health care, etc., and Obama takes the credit. Not even a “thank you.” If we could keep even a fraction of that money, maybe we could afford to pay our own education and health care costs.

How about acknowledging that for every Life of Julia there’s a Life of Paul and presenting their stories in juxtaposition to show how, as with any policy, some people are better off and some people worse.

Life of Julia

Life of Paul

As she prepares for her first semester of college, Julia and her family qualify for President Obama’s American Opportunity Tax Credit—worth up to $10,000 over four years. Julia is also one of millions of students who receive a Pell Grant to help put a college education within reach.

As they go into debt to pay for their own child’s college education, Paul and his wife are required to pay for Julia’s college tuition as well.

You see the idea? Let’s try another one . . .

Life of Julia

Life of Paul

Julia decides to have a child. Throughout her pregnancy, she benefits from maternal checkups, prenatal care, and free screenings under health care reform.

Paul’s wife is diagnosed with a life-threatening medical condition. Although they have health insurance, which they pay for themselves, there are deductibles, co-pays and out-of-pocket expenses, as well as the financial implications of his wife’s inability to work. They receive no government assistance, which is fine, but their financial woes are compounded by the fact that they are also required to pay for Julia’s “free” medical care.

The money being used to buy the votes of millions of Julias out there is not coming exclusively or even primarily from unnamed “millionaires” on “Wall Street” . . . it’s coming from “middle class” “hard-working Americans” on “Main Street” who are struggling.

I’m angry. Not just because the southern coastline of our nation — including Louisiana, which I purchased from Napoleon in the sweetest deal of 1803 — is being destroyed.

Read these pathetic remarks from our president, Barack Obama:

The president also implied that anti-big government types such as tea party activists were being hypocritical on the issue.

“Some of the same folks who have been hollering and saying ‘do something’ are the same folks who, just two or three months ago, were suggesting that government needs to stop doing so much,” Obama said. “Some of the same people who are saying the president needs to show leadership and solve this problem are some of the same folks who, just a few months ago, were saying this guy is trying to engineer a takeover of our society through the federal government that is going to restrict our freedoms.”

Many large companies are examining a course that was heretofore unthinkable, dumping the health care coverage they provide to their workers in exchange for paying penalty fees to the government.

That would dismantle the employer-based system that has reigned since World War II. It would also seem to contradict President Obama’s statements that Americans who like their current plans could keep them. And as we’ll see, it would hugely magnify the projected costs for the bill, which controls deficits only by assuming that America’s employers would remain the backbone of the nation’s health care system.

Experience hath shewn, that even under the best forms of government those entrusted with power have, in time, and by slow operations, perverted it into tyranny.

— TJ

My fellow Americans —

This is a glorious day in our great nation! No, I’m not referring to that tragedy of a health care bill, which I’ll get to in a moment. I’m talking about Free Pastry Day at Starbucks! Who doesn’t enjoy a tasty scone with his morning coffee?

Now, on a more somber note . . .

Goodbye, representative democracy! Farewell, consent of the governed!

President Obama today signed into law a far-reaching measure that will affect everyone living in these United States, now and in the future. It is opposed by most of the country and it is now law.

I would never have believed that the government I helped to establish would one day engage in this kind of forced sodomy against its own people.

We know what is right and we will do it, regardless of whether you want it done to you or not.

If Karl Marx were here, he would no doubt make a case for trading off liberty in favor of whatever it’s called when a centralized authority redistributes your income in the interest of “equality.” If you know even a little bit about American history, I guess you know which side of that fence old Tom Jefferson is on.

Switching from politics to economics: People with insurance use more health care resources than people without. Put another stitch in my head, doc! I’ve got insurance!

If more people have insurance, it will increase the demand for health care, which in turn will increase the price.

Now imagine that everyone has insurance. I got your health care reform right here: We’re going to drive the price of health care through the roof, then spend a titanic amount of money helping poor people afford it.

I have no (proven) living descendants and for that I say — Thank God! The next generation of Americans is going to be crushed under the burden of paying for this misguided vision of government.

Pig-in-a-poke is an idiom that refers to a confidence trick originating in the Late Middle Ages, when meat was scarce but cats were not.

The scheme entailed the sale of a suckling pig in a poke (bag). The wriggling bag would actually contain a cat (not particularly prized as a source of meat) that was sold to the victim in an unopened bag.

A common colloquial expression in the English language, to buy a pig in a poke is to make a risky purchase without inspecting the item beforehand. The phrase can also be applied to accepting an idea or plan without a full understanding of its basis.

Rep. John Murtha of Pennsylvania, a longtime fixture on the House subcommittee that oversees Pentagon spending, died after complications from gallbladder surgery, according to his office. He was 77.

The Democratic congressman recently underwent scheduled laparoscopic surgery at National Naval Medical Center in Bethesda, Maryland, to remove his gallbladder. The procedure was “routine minimally invasive surgery,” but doctors “hit his intestines,” a source close to the late congressman told CNN.

I will actually give you a speech made up entirely–almost at the spur of the moment, of what a candidate for president would say if that candidate did not care about becoming president. . . .

“Thank you so much for coming this afternoon. I’m so glad to see you, and I would like to be president. Let me tell you a few things on health care. Look, we have the only health-care system in the world that is designed to avoid sick people. [laughter] That’s true, and what I’m going to do is I am going to try to reorganize it to be more amenable to treating sick people. But that means you–particularly you young people, particularly you young, healthy people–you’re going to have to pay more. [applause] Thank you.

“And by the way, we are going to have to–if you’re very old, we’re not going to give you all that technology and all those drugs for the last couple of years of your life to keep you maybe going for another couple of months. It’s too expensive, so we’re going to let you die. [applause]

“Also, I’m going to use the bargaining leverage of the federal government in terms of Medicare, Medicaid–we already have a lot of bargaining leverage–to force drug companies and insurance companies and medical suppliers to reduce their costs. But that means less innovation, and that means less new products and less new drugs on the market, which means you are probably not going to live that much longer than your parents. [applause] Thank you.”